II. Definitions
- Jehovah's Witness
- Religious denomination founded in the U.S. in the late 19th century
- As part of religious beliefs, Jehovah's Witnesses generally refuse Blood Transfusions and other blood-based treatments
- Practices vary, and some patients agree to albumin, Clotting Factors and IVIG but refuse cellular products
- Bloodless Medicine
- Practice to reduce the risk of life threatening Anemia in the perioperative period
III. Management: Preoperative Care
- Increase baseline Hemoglobin prior to surgery
- Supplement in the weeks before elective surgery
- Iron Supplementation
- Vitamin B12 Supplementation
- Folic Acid supplementation
- High risk bleeding procedures
- Epoetin Alfa 600 units/kg each week for 4 weeks
- Biosimilar agent Retacrit does not contain Albumin (in contrast to Epogen, Procrit)
- Supplement in the weeks before elective surgery
- Hold medications that increase bleeding risk (if possible)
- See Medications to Avoid Prior to Surgery
- Anticoagulants
- Antiplatelet Agents
- NSAIDs
- Ginkgo Biloba
- Indications for preoperative Desmopressin
IV. Management: Perioperative Care
- Limit blood loss
- Cell Salvage Autotransfusion Devices (e.g. Cell Saver)
- Minimimally Invasive Surgical Procedures
- Avoid Hypothermia (increases risk of Coagulopathy)
- Consider Hemostatic Agents
- Consider Tranexamic Acid
- Have Topical Hemostatic Agents readily available
- Fibrin Sealants (e.g. Tisseel)
- Topical Thrombin (e.g. Recothrom)
V. Management: Postoperative Care
- Limit postoperative blood draws
- Consider pediatric blood tubes
- Consider point of care finger stick levels
- "Bloodless" Agents that increase Hemoglobin
- Parenteral Iron (e.g. Venofer) in Iron Deficiency
- Epoetin Alfa in severe Anemia
- Effects are delayed by at least 4 days
- Other measures for life-threatening Anemia (e.g. Hemoglobin <5 g/dl)
- Hyperbaric Oxygen
- Bovine Hemoglobin-based oxygen carrier (e.g. Hemopure IV)